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Commonwealth of Official Use Only
a.
® Massachusetts Permit No. BLDE-18-007317
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
PRev.l/07)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:6/26/2018
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives ndtce othts or her intention to perform the electrical work described below.
Location(Street&Number) 16 CHERUB LN
Owner or Tenant POWER BOBBI-JEAN Telephone No.
Owner's Address 16 CHERUB LN,SOUTH YARMOUTH,MA 02664
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead 0 Undgrd 0 No.of Meters
New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Remodel bathroom.
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above 0 In- ❑ No.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets 1 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches 3 No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond, Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local O Municipal 0 Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:'
No,of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to start: Inspection to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE:Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee
provides proof of liability insurance including"completed operation"coverage or its substantial equivalent.The undersigned certifies that such
coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE:INSURANCE 0 BOND 0 OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: Gary L Gordon
Licensee: Gary L Gordon Signature LIC.NO.: 15290
(Ijapplicable,enter"exempt"in the license number line.) Bus.Tel No.:
Address:37 BILLINGSGATE DR,DENNIS MA 026382234 Alt.Tel.No.:
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License:
OWNER'S INSURANCE WAIVER:I am aware that the License does not have the liability insurance coverage normally required by law.But
signature below,I hereby waive this requirement.I am the(check one) 0 owner ❑ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$75.00
J 6127118 (s.
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BOARD OF FIRE PREVEN110N REGULATIONS Occo� �FeG�
( f (leave blank)
A)I APPLICATION FOR.PERMIT TO PERFORM ELECTRICAL WORK
.w wort to be psmrmed in amoriao¢with tire Ricca tome IIe<aieal Cad(MEC)j-27 Dal
(/f/�_ (PLEASEPRINT DI DX.OR TYPE ALL WF'DRila7707>) Date:
b City or Town of Y MQ II To the Inspector of Wires:. By this application the pndertgaed;vex notice of his or her totem:ion to perform the electrical work described below.
(re 1 Location(S reet&Number) / .
V e
Own et
[ f �WP� Telephone No.
Owner's Address __________
Is this permit in conjanetionwith ae � Yes No 0 PeaAnprupriai Box)
Purpose e31ci�
rpose of E .t
S� /t 6rIInTctp Authorization Na
7 Existing Service ��Q Amps pc l 0 Volts Overtiead U yr / ,94
New S�vict r�— `�� � n� ❑ No.of t$etei s (/
CZ 1,----"1 ems and.,mps' / Volts Overheat ❑ Undrd 0 No.of Mets _
Namb�of F 4mg ±y c //oT+t rll�tf T ��/
Location and N r
:� o Efate of Pronn Elxhieel work
=
..i in - Completion of dm fodawirmtablean be waived iydr tr r h
ocJ1 t Iotal.
of t tied r„n . .e INA of Cal-Sosp (Paddle)Fans • ITorasformxKVAUZNa of Luminaire pay INA of Hot Tubs Groaatom • KVA'ut! —i Z)
I_ 1 •
Na ofLamiaaire IS gPool '� 0 In-d. ❑ Ito.ofnmcg-�cyixgaa:
_- Na ofReL I�atLrgII>sffs
Pta"t•cart.=t ./ No.or OU Errass len ALARMS IND,of Zone
No.of Switch= 7 - No.of Gas Yarmc
110,of)eSzrnDh aid
,� No-of Pimps • otsl ef.k Alm
D=eities
Na of Air Coad
No.of Wrath D' Tons tin.of Alm-tin Devices
Disposers I ` er Tons I!CM run=e ltie
roix]s:I (
Na of Dishwashers Local
El S]a nn¢Devrta
®r. IS�arJAsea Heating Kp7• �l❑DvT�iai�al ;
No.of DryersCntmetdinn 0 Ott
V No.of Wer No. APPGanra Na of Security of ofttor or talent
Heaters K"W Ballast �zsa Wving
SinsNo.of Devices or covalent •
No.Hydromassage Bathtubs No.of Motors Total HP
Aaarh additional detail(desired or ra required by the Inspector ofWires.Estimated Value of Elnctri wort /off co..----(When required by municipal policy.)Iv
bVi wort to Start a Insp-xtioas to be rogoesizd in accordance with MEC Rule 10,and n
INSURANCE VERAGE: Unless waived by the owner,no cunt for the ° comply8sn
the licensee provides proof ofliabilityP performance of ies substantial
worklmay issuelent The
• �' lmdizsi c insurance including"completed operation”coverage or its substffitial�"alcnt TLe
geed citifies that such coverage is in force,and has exhibited proof of same to the permit issuing omce.
CHECK ONE NSURANCESa. BOND 0 OT}fl 0 (specify.)
> cc4iIR/HI NAME:the pa �pof peuray,that the informa on on Bis application it Ave and can t=ie.
o - , Sri"f a_,
Licensee TIC.NO.: / 9 0
v a —r_
(Jf placable,enter"- .. ,., -in the Acov Steatite �.��� LIG NO.:Slag_
Address: -3 J ;/fIL, n�`� �/ BAlt
TeLN
.,,I `Per)LC.L.e. f 47,s.S7-6I,sr city work regaues Department ot'Publie S TeL No..� T
Q OWNER'S INSURANCE WAIVER: Safety "elaaaC Lie.No.
required by taw. ByIam aware that the Licensee does nor have the liability iasvnate —�--
r quired at wy signa�c below•I hereby waive this requiremcat t am the(cheek one)[]owner tQ1�dot, e
Signatmc
\i Telenhaae Ma onion-cern. -